title: Evaluation of duct-cell and acinar-cell function and endosonographic abnormalities in patients with suspected chronic pancreatitis.
abstract: OBJECTIVE
  Endoscopic ultrasound (EUS) detects mild and severe structural abnormalities of the pancreas that correlate with fibrosis. Direct pancreatic function tests (PFTs) detect mild exocrine insufficiency associated with early fibrosis. The primary aim of this study was to compare EUS structural criteria with duct-cell and acinar-cell function.
  
  
  METHODS
  Fifty patients evaluated for chronic pancreatitis underwent combined EUS and secretin endoscopic PFTs (ePFT) on day 1 and CCK ePFT on day 2. EUS images were videotaped and interpreted by consensus of 3 blinded expert reviewers.
  
  
  RESULTS
  There were inverse correlations of EUS consensus score with both duct-cell bicarbonate secretion (R = -0.71, P < .001) and acinar-cell lipase secretion (R = -0.52, P < .001). With secretin ePFT as reference standard, EUS (>or=4 criteria) showed a sensitivity of 71% (95% confidence interval [CI], 53%-89%) and specificity of 92% (95% CI, 75%-99%). With CCK ePFT as reference standard, EUS had a sensitivity of 63% (95% CI, 43%-82%) and specificity of 85% (95% CI, 71%-98%). Main duct dilation, irregularity, calcifications, and visible side-branches were most predictive of exocrine insufficiency (positive predictive value >80% for both acinar- and duct-cell insufficiency).
  
  
  CONCLUSIONS
  Acinar- and duct-cell function decreases as EUS structural abnormalities increase. EUS has fair sensitivity and very good specificity compared with secretin and CCK functional reference standards.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. stevent@ccf.org
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.forename: John A
authors.initials: JA
authors.lastname: Dumot
authors.forename: Gregory
authors.initials: G
authors.lastname: Zuccaro
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.forename: Edward
authors.initials: E
authors.lastname: Purich
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
mesh_terms: D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000032:analysis; D002766:Cholecystokinin; D016145:Endoscopy, Digestive System; D019160:Endosonography; D005260:Female; D006801:Humans; D008049:Lipase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D010186:Pancreatic Function Tests; D050500:Pancreatitis, Chronic / Q000175:diagnosis*; D011859:Radiography; D012633:Secretin; D012680:Sensitivity and Specificity
chemical_list: D001639:Bicarbonates; D012633:Secretin; D002766:Cholecystokinin; D008049:Lipase